Speckle Tracking Stress Echocardiography Research Articles

Left ventricular regional longitudinal strain assessed during speckle-tracking stress echocardiography with physical exercise may identify severe coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Assessment of global longitudinal strain of the left ventricular (LV) myocardium during stress echocardiography showed promising results in diagnosing transient myocardial ischemia. Regional longitudinal strain (RLS) allows to evaluate LV systolic function more precisely. However, due to the heterogeneity of LV segments contraction, an isolated assessment of LV RLS values can be challenging. We suggest that evaluation of the mean LV RLS values for the basal, middle and apical regions of the LV during stress echocardiography may be more useful in clinical setting. Aim of the study. The aim of the study was to determine the diagnostic capabilities of the LV RLS assessed during stress echocardiography with exercise on the treadmill in defining the presence and significance of coronary artery disease (CAD). Methods. The study included 132 patients (65.0 ± 9.3 years, 85 men) with known or suspected CAD. All patients underwent speckle-tracking stress echocardiography with exercise on the treadmill. At rest and after treadmill test all patients were measured for the values of LV RLS using the AFI (Automated functional imaging) algorithm. The LV RLS values for basal, middle and apical regions were calculated as the ratio of the sum of LV RLS values of the segments of each region to the number of segments. Segments of the LV were represented with the standard 17-segment model of the LV, 1-6 segments were assigned as basal segments; 7-12 segments as middle segments and 13-17 as apical segments (Picture 1). All patients underwent coronary angiography; the severity of CAD was assessed using the Gensini score. According to the results of coronary angiography, patients were divided into 3 groups: group 1 – 42 patients without CAD, group 2 – 63 patients with moderate CAD (<34 points on the Gensini score) and group 3 – 27 patients with severe CAD (≥ 35 points on the Gensini score). Results. At rest LV RLS values in basal, middle and apical regions did not significantly differ between the groups. Picture 2 shows that after the load, LV RLS values in basal, middle and apical regions in patients with severe CAD were significantly lower than in groups of patients without CAD and with moderate CAD. The values of LV RLS in patients with severe CAD decreased in all regions after the load, while in patients without CAD and with moderate CAD, LV RLS values increased in middle and apical regions and decreased in basal region. Conclusion. In patients with severe CAD (≥ 35 points on the Gensini score) after the load on the treadmill LV RLS values in all regions were significantly lower than in patients without CAD and with moderate CAD. Thus, LV RLS assessed during speckle-tracking stress echocardiography on the treadmill may be useful in identifying patients with severe CAD. Abstract Figure. Picture 1. 17-segment model of the LV Abstract Figure. Picture 2. Results of stress test

Diagnostic value of postsystolic shortening of the left ventricular myocardium assessed during speckle tracking stress echocardiography on the treadmill in patients with coronary artery disease.

Aim To evaluate the diagnostic capacity of left ventricular (LV) postsystolic shortening (PSS) values obtained by speckle-tracking stress-echocardiography (stress-EchoCG) using a treadmill test in determining the functional significance of the degree of coronary artery (CA) stenosis.Material and methods The study included 132 patients (80 men aged 65.0±9.3 years) with suspected or previously verified diagnosis of ischemic heart disease. Stress-EchoCG with the treadmill test was performed for all patients. Strain parameters were determined by two-dimensional speckle-tracking on gray-scale images before and after the exercise. Values of LV postsystolic index (PSI) and LV mean postsystolic time (PST) were calculated. Coronary angiography was performed for all patients. Patients were divided into 3 groups based on the severity of CA stenosis according to the G. G. Gensini score.Results LV PSS values at rest did not significantly differ between the patient groups. After completion of the exercise, the mean LV PSI was significantly higher for patients with pronounced CA stenosis than in the group without CA stenosis or with moderate CA stenosis: 8.9 % [3.8; 10.7 %] vs. 3.8 % [2.2; 6.8 %] (p=0.012) and 3.4 % [2.2; 6.2 %] (p=0.012), respectively. The mean LV PSI after completion of the exercise indicated the presence of pronounced CA stenosis with a sensitivity of 75 % and a specificity of 61 % (area under the curve, AUC, 0.74±0.06; р<0.001). After completion of the exercise, the mean LV PST was significantly greater for patients with pronounced CA stenosis than in the group without CA stenosis or with moderate CA stenosis: 27.4 [18.7; 34.7] ms vs. 18.4 [10.8; 26.5] ms (p=0.036) and 20.9 [14.2; 29.5] ms (p=0.036), respectively. The mean LV PST after completion of the exercise exceeding 23.5 ms suggests pronounced CA stenosis with a sensitivity of 71 % and a specificity of 65 % (AUC 0.69±0.06; p=0.004). A complex evaluation of the LV PSI, the LV local contractility disorder (LCD) index, the LV PST, and LV LCD index allows enhancement of the test sensitivity in diagnozing pronounced CA stenosis.Conclusion Determination of LV PSS in speckle-tracking stress-EchoCG may be useful for evaluating the functional significance of the degree of CA stenosis to enhance the sensitivity of stress-EchoCG in patients with pronounced CA stenosis.

Speckle Tracking Stress Echocardiography on Treadmill in Assessment of the Functional Significance of the Degree of Coronary Artery Disease.

Aim To determine diagnostic capabilities of left ventricular (LV) global longitudinal systolic strain (GLSS) in stress echocardiography (stress-EchoCG) with a treadmill test for diagnosing the functional significance of the degree of coronary stenosis.Material and methods The study included 121 patients (73 men aged 68.3±7.7 years) with suspected or previously diagnosed ischemic heart disease (IHD). Speckle-tracking stress-EchCG (method of tracking speckles on two-dimensional gray-scale ultrasonic images) with a treadmill test and coronarography was performed for all patients. The patients were divided into 3 groups based on the severity of coronary artery (CA) stenosis according to the Gensini scale.Results LV GLSS at rest did not significantly differ between the study groups. After the exercise, LV GLSS was significantly lower in patients with pronounced CA stenosis than in patients without or with moderate CA stenosis (15.9±4.6 % vs. 20.6±3.7 % (p<0.001) and 19.6±3.0 % (p=0.003), respectively). Postexercise LV GLSS <16.9% suggested a pronounced CA stenosis with a sensitivity of 80% and a specificity of 70% (area under the curve, AUC, 0.76±0.06 at 95 % confidence interval, CI, 0.63-0.89; р<0.001). In the patient group without CA stenosis, LV GLSS showed a significant increase after completion of the exercise (from 19.1±3.1 to 20.6±3.7; p=0.04).Conclusion Evaluation of LV GLSS and its dynamics in stress-EchoCG with a treadmill test may be promising in patients with IHD, since in most patients with pronounced CA stenosis, LV GLSS is reduced at baseline and further reduces in response to exercise. In patients without CA stenosis, LV GLSS increases after completing the exercise.

Evaluation of strain parameters during stress-echocardiography with physical exercise may be significant in detecting severe coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background. Assessment of the left ventricular strain during speckle-tracking stress echocardiography may be significant in diagnosing transient myocardial ischemia. So it is challenging to evaluate left ventricular global longitudinal strain (GLS) and post-systolic shortening indicators during stress-echocardiography and compare their diagnostic value with the data obtained with invasive methods of diagnosing coronary artery disease (CAD). Aim of the study. The aim of this study was to determine the diagnostic capabilities of the left ventricular GLS, delta GLS, left ventricular post-systolic index (PSI) and post-systolic time (PST) obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods. The study included 113 patients (mean age 64.8 ± 9.4 years; 43 females) with known or suspected CAD. All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of left ventricular GLS, left ventricular PSI and PST using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLS values was also counted. The delta of the left ventricular GLS values was counted as the difference of the left ventricular GLS values after the load and at rest. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 41 patients without CAD, 53 patients with moderate CAD (≤34 points on the Gensini score) and 19 patients with severe CAD (>35 points on the Gensini score). Results. In the group of patients with severe CAD, values of left ventricular GLS after the load significantly differed from the group of patients without CAD (16,1 compared with 20,3; p = 0,003) and from the group of patients with moderate CAD (16,1 compared with 19,4; p = 0,003). At rest GLS values didn’t differ significantly between all groups. Left ventricular GLS delta in the group of patients with severe CAD differed significantly with the group of patients without CAD (-1,8 compared with 1,3; p = 0,003) and with the group of patients with moderate CAD (-1,8 compared with 0,6; p = 0,03). Left ventricular PSI differed significantly between the group of patients with severe CAD and the group of patients without CAD after the load (8,4 compared with 5,1; p = 0,03) and at rest didn’t differ significantly. Left ventricular PST values didn’t differ significantly at rest and after the load in all groups. Conclusions. Strain parameters such as left ventricular GLS, left ventricular GLS delta and left ventricular PSI assessed during stress-echocardiography on the treadmill may be useful in identifying patients with severe CAD. Left ventricular PST didn’t show significance in identifying CAD.

Speckle tracking stress echocardiography: A valuable diagnostic technique or a burden for everyday practice?

Non-invasive screening for early diagnosis of coronary artery disease (CAD) represents a key element in the never-ending challenge to reduce cardiac death. Stress/rest electrocardiogram often lacks diagnostic accuracy, especially in asymptomatic patients, in fact the latest guidelines for the diagnosis and management of chronic coronary syndromes (CCS) stated the superiority of functional imaging techniques for the detection of subtle myocardial ischemia and the evaluation of myocardial viability (MV). Stress echocardiography is the most accessible and inexpensive imaging method for the study of CAD, either with pharmacological or with exercise provocative stress, based on visual wall-motion assessment. However, in some cases, such as small coronary lesions or microvascular angina, it loses its diagnostic power, therefore requiring a more sensitive approach. Accordingly, in the last years many authors investigated the possible additive value provided by the integration of an advanced but easy-to-obtain technique, that is speckle tracking imaging, to stress echocardiography, reaching promising results; nevertheless, its use is not included in the latest recommendations for CCS. The present review discusses the potential benefits from using a combination of speckle tracking and stress echocardiography for the early detection of myocardial ischemia and the assessment of MV and its suitability in different clinical scenarios, basing on the available evidence.

Speckle tracking stress echocardiography in children: inter- and intraobserver reproducibility and the impact of echocardiographic image quality

Purpose. Speckle tracking echocardiography (STE) is increasingly used during functional assessments. However, reproducibility and dependence on echocardiographic image quality for speckle tracking stress echocardiography in pediatric patients have not been studied to date. Methods. 127 consecutive normotensive children …

Speckle tracking stress echocardiography in children: inter- and intraobserver reproducibility and the impact of echocardiographic image quality

Speckle tracking stress echocardiography in children: inter- and intraobserver reproducibility and the impact of echocardiographic image quality

Quantitative Assessment of Myocardial Ischemia in Multi-Vessel Coronary Artery Disease by Multimodal Stress Echocardiography with Semi-Supine Bicycle Ergometry

Stress echocardiography is a modern widely used method of noninvasive diagnosis of coronary heart disease and stratification of the risk of cardiovascular complications. In addition, exercise echocardiography is an important tool to clarify the localization of ischemia and establish a symptomassociated artery for management of patient with known coronary angiography data. This is especially important in multivessel lesions, the presence of an occluded artery or borderline stenosis. Currently, various stress agents are used for stress echocardiography in clinical practice: pharmacological drugs (dobutamine or adenosine), transesophageal or endocardial pacing, treadmill, semi-supine bicycle. To detect signs of ischemia usually used only visual estimation of local contractility in the two-dimensional gray-scale mode. Modern modes of myocardial imaging, such as speckletracking echocardiography or three-dimensional visualization, are practically not used. In the presented clinical case, the possibility of combining standard and modern imaging modes to clarify the localization and quantification of ischemia in multivessel coronary lesions, including chronic artery occlusion, is shown. As a stress agent, a semi-supine bicycle was chosen, the use of which allowed to obtain a qualitative image of the left ventricular myocardium at rest and at peak load, suitable for assessing deformation and threedimensional visualization. Evaluation of left ventricular myocardial deformation by speckle-tracking echocardiography was more accurate than standard diagnosis in detecting signs of ischemia in a patient with multivessel lesions. Three-dimensional imaging was inferior in sensitivity to speckletracking stress echocardiography and, at present, seems to have more research value.

P1399 Global longitudinal systolic deformation of the left ventricle during stress echocardiography with physical exercise may identify patients with severe coronary artery disease

Abstract Background Assessment of longitudinal systolic deformation of the left ventricular myocardium during speckle tracking stress echocardiography can potentially be significant in the diagnosis of transient myocardial ischemia. In this regard, determination of the global longitudinal systolic deformation (GLSD) of the left ventricle during stress echocardiography is challenging and its diagnostic capabilities can be assessed by comparing them with the data obtained with invasive methods for diagnosing coronary artery disease (CAD). Aim of the study The aim of this study was to determine the diagnostic capabilities of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods The study included 80 patients (mean age 68.3 ± 7.8 years; 29 females). All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of the left ventricular GLSD using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLSD values was counted. The delta of the left ventricular GLSD values was counted as the difference of the left ventricular GLSD values at rest and after the exercise. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 21 patients without CAD, 45 patients with moderate CAD (<34 points on the Gensini score) and 14 patients with severe CAD (> 34 points on the Gensini score). Results In the group of patients with severe CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test significantly differed from the groups of patients with moderate CAD and without CAD (-0.56 compared with 2.17; p = 0,009). In the group of patients without CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test did not significantly differ from the group of patients with CAD (0.23 compared to -0.95; p = 0.199). Conclusions The delta of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill showed a reliable significance in determining severe CAD, but did not demonstrate a reliable significance in identifying the absence of CAD.

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

CAPABILITIES AND LIMITATIONS OF SPECKLE TRACKING STRESS ECHOCARDIOGRAPHY

Stress echocardiography is a technique that allows to evaluate myocardial contractility and intracardiac hemodynamics under conditions of physical exercise or reaction to a pharmacological drug. Evaluation of systolic function of the left ventricle plays an important role in establishing the prognosis and choosing a treatment strategy for various cardiovascular diseases. Speckle tracking technique is one of the most promising methods for determining values of left ventricular deformation, due to which not only visual, but also quantitative assessment of left ventricular myocardial contractility is possible at rest and during stress tests. In this review, we analyzed the possibility of using speckle tracking stress echocardiography with physical exercise or with the pharmacological drug, in order to diagnose various diseases, such as ischemic heart disease, valvular heart disease, diabetes mellitus, and microvascular damage. Along with this, differences between the values of the longitudinal systolic deformation depending on age were considered. We also compared diagnostic values of the data of speckle-tracking stress echocardiography and coronary angiography and values of the data of speckle-tracking stress echocardiography and computed tomography of the coronary arteries.

Speckle tracking stress echocardiography in children: interobserver and intraobserver reproducibility and the impact of echocardiographic image quality

Speckle tracking echocardiography (STE) is increasingly used during functional assessments. However, reproducibility and dependence on echocardiographic image quality for speckle tracking stress echocardiography in pediatric patients have not been studied to date. 127 consecutive normotensive children without structural heart disease (mean age 13.4 ± 3.0 years, 50.4% female) underwent a stepwise semisupine cycle ergometric protocol. Left ventricular (LV) myocardial peak strain and strain rate were assessed at rest and during exercise. Interobserver and intraobserver assessments were performed and analyzed regarding echocardiographic image quality. LV peak global strain and strain rate were well reproducible with narrow limits of agreement without any significant bias both at rest and during all stages of exercise testing. Moreover, strain rate reproducibility slightly deteriorated in values between −1.5 and −3 s−1. Surprisingly, there was no significant difference in reproducibility between optimal, intermediate and poor quality of echocardiographic images. STE derived strain and strain rate measurements in children are feasible and highly reproducible during semisupine cycle ergometric stress echocardiography. Echocardiographic image quality does not seem to influence strain (rate) reproducibility. Myocardial deformation measurements in images with suboptimal visualization quality must be interpreted with caution.

Speckle Tracking Stress Echocardiography Uncovers Early Subclinical Cardiac Involvement in Pediatric Patients with Inflammatory Bowel Diseases

Inflammatory bowel disease (IBD) is an established risk factor for cardiovascular disease (CVD). However, whether cardiac consequences present early in IBD is unknown. This is the first study in children aiming to unmask altered myocardial mechanics in IBD. We enrolled 50 consecutive normotensive children with Crohn’s disease (CD) (n = 28) or ulcerative colitis (UC) (n = 22). The study groups consisted of 18 patients with active inflammatory disease (mean age 14.6 ± 2.5 years) and 32 children with IBD in remission (14.3 ± 2.3 years). 60 age- and gender-matched children served as healthy controls. Speckle tracking stress echocardiography (STE) was used to assess left ventricular (LV) myocardial strain and strain rate. Circumferential strain rate was significantly decreased in children with active IBD (−1.55 ± 0.26 s−1) and IBD in remission (−1.49 ± 0.26 s−1) versus healthy controls (1.8 ± 0.4 s−1) both at rest (p < 0.001) and during exercise (p = 0.021). Moreover, longitudinal strain rate, circumferential strain and E/E′ ratio were significantly impaired in IBD. Pediatric patients with IBD feature subclinical signs of LV systolic and diastolic myocardial impairment early in the course of CD and UC. This may not be reversible even when IBD is clinically controlled. Patients with IBD should be regularly screened for signs of CVD.

Subclinical Alterations of LV Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study

Objectives: Non-ischemic diabetic cardiomyopathy considerably accounts for mortality in diabetes mellitus. The mechanism underlying diabetes associated heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes is scarce. In this study we utilize speckle tracking echocardiography combined with physical stress testing to evaluate whether left ventricular (LV) myocardial contractility is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM).

Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study.

Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.

Hybrid imaging with coronary tomography and 3D speckle-tracking stress echocardiography fusion

A 61-year-old male patient with diabetes mellitus and hypertension was referred because of exertional chest pain. Coronary angiography was performed, and severe stenosis at the mid-segment of left anterior descending (LAD) artery, marginal obtuse branch of the circumflex artery, and descending posterior branch of the right coronary artery were assessed. Distal vessels were not …